胃癌化疗后浆膜腔大B细胞淋巴瘤一例报道并文献复习

A case report and literature review of large B-cell lymphoma in the serous cavity after chemotherapy for gastric cancer

目的探讨胃癌化疗后出现浆膜腔大B细胞淋巴瘤的诊断学特征。方法回顾性分析2023年1月1日潍坊市人民医院收治的胃癌化疗后出现浆膜腔大B细胞淋巴瘤1例患者的临床及病理资料,结合文献,总结其诊断学特征。结果患者女性,71岁,在胃癌化疗1.5年后,出现咳嗽咳痰、活动后胸闷憋喘,患者于2022年9月行全胃切除加区域淋巴结清扫,术后病理示:全胃低分化腺癌,病理学分期:ypT4aN0Mx,肿瘤退缩分级:3级。行胸部CT示左侧胸腔积液。B淋巴细胞基因重排示B细胞受体出现单克隆性重排;淋巴瘤免疫分型(流式细胞仪法)示CD5-CD10-的单克隆B细胞占有核细胞的11.4%。根据临床资料、形态学特征、免疫细胞化学染色、基因重排和流式细胞术结果,病理诊断为以胸腔积液为主要表现的大B细胞淋巴瘤。患者确诊后5.5个月,仍以胸腔积液为主要表现,未出现全身淋巴结的肿大。结论癌症化疗后出现以胸腔积液为主要表现的大B细胞淋巴瘤需要注意鉴别。病理形态学和免疫细胞化学染色特征可用于诊断胸腔积液中的淋巴瘤细胞。

Objective To explore the diagnostic features of large B-cell lymphoma of the serous cavity after chemotherapy for gastric cancer.Methods A retrospective analysis of a case with large B-cell lymphoma in the serous cavity that occurred after chemotherapy for gastric cancer in a patient admitted to Weifang People′s Hospital on January 1,2023 was performed,including clinical and pathological data,combined with literature review,to summarize the diagnostic features.Results The patient,a 71-year-old female,developed cough and phlegm 1.5 years after chemotherapy for gastric cancer,and chest tightness and dyspnea after activity.The patient underwent total gastrectomy plus regional lymph node dissection in September 2022,and the postoperative pathology showed poorly differentiated adenocarcinoma of whole stomach.The pathological stage was ypT4aN0Mx,and the tumor regression grade was 3.Chest CT showed a left pleural effusion.B lymphocyte gene rearrangement:monoclonal rearrangement of B cell receptors was observed.Lymphoma immunophenotyping(flow cytometry method):monoclonal B lymphocytes that were negative for CD5 and CD10,accounted for 11.4%of nucleated cells.According to the clinical data,morphological features,immunocytochemical stain results,gene rearrangement and flow cytometry,the pathological diagnosis was large B-cell lymphoma with pleural effusion as the main manifestation.5.5 months after diagnosis,the patient still had pleural effusion as the main manifestation,without systemic lymph node enlargement.Conclusions Large B-cell lymphoma with pleural effusion diagnosed as the main manifestation after cancer chemotherapy should be distinguished.Pathologic and immunocytochemical stain features can be used to diagnose lymphoma cells in pleural effusion.